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Do No Harm

By Deborah Gennarelli, M.Ed.


A fundamental guiding principle for physicians is “First, do no harm.” As part of the Hippocratic Oath (an oath of ethics), doctors must consider the possible harmful effects that any intervention they recommend might have on their patients. This principle should also guide those who work with children. Educational decisions made in schools every year should never be carried out until all stakeholders can say that the child’s best interest was their primary concern and that the child is likely to benefit without harm. 


Working in schools today is an incredibly difficult job. Teachers wear many hats as they work with large groups of children with diverse needs. Like me, many individuals enter the teaching profession because of their desire to make a difference and a love for working with children. They never intend to harm any child with decisions that are made.  However, in my long career working with gifted and twice-exceptional students, I have observed too many instances when this unique group of students suffered in school for several reasons:  1. Adults believed myths over truths.  2. Adults made the wrong diagnosis or did not make a formal diagnosis at all; and 3, adults failed to provide the correct type of accommodations or adjustments so the student could thrive instead of just survive. 


Myths

First, myths that surround gifted and 2e children are very hurtful. It is important for all adults who work with these students to be knowledgeable and prevent untruths from spreading. For example, when a teacher thinks “All children are gifted,” they do not fully understand the definition of giftedness.  Gifted refers to a different way of being; it is a form of neurodiversity. Although there is no universally accepted definition of this term, most gifted education experts agree that a gifted individual demonstrates outstanding levels of aptitude or competence in one or more domains. Teachers and parents should be aware of the broad categories of giftedness. They include general intellectual ability, specific academic aptitude, creative thinking and production, leadership/psychosocial ability, psychomotor ability, and ability in the visual and performing arts. When a student is identified in one or more of these areas, services or activities are needed to help fully develop the student’s capabilities. These can include, but are not limited to, the following:


  • cluster grouping of gifted students in the regular classroom.

  • subject or whole grade acceleration.

  • mentorships. 

  • independent study.

  • gifted programing staffed by trained gifted intervention specialists.

  • dual enrollment opportunities that allow high school students to take college-level classes.

Additionally, there is the myth that “Gifted children’s emotions are like other children.” This is sometimes true. However, the more highly gifted the child, the more likely he/she is to demonstrate emotional intensity and particular sensitivity. Just as the gifted child’s thinking is more complex than other students, so are their emotions. Feeling everything more deeply than others can be extra painful and frightening. Emotionally intense gifted students often must cope with inner conflict, self-criticism, anxiety, and feelings of inferiority. These emotions are very often brought on by a sense that they must do more than others, like write the perfect paper or solve one of the world’s great problems. To protect this child, we should help them understand that experiencing emotions more intensely than others is part of their way of being. Parents and teachers can help students use their keen intellect and insight to develop self-awareness and self-acceptance. 


Finally, I cannot count the number of times, while working with school staffs, I had to debunk the myth, “Smart kids cannot have learning differences.”  Twice-exceptional students (and adults) who possess both strengths and weaknesses have unique and often quite challenging needs. It is unfortunate we do not know how many 2e children are in our schools because so many of them are never formally identified. In classrooms, these children are most noticed for what they cannot do, not for a specific talent they may demonstrate. 


There is no federal definition that covers 2e students. However, the Joint Commission on Twice-Exceptional Students, representing The National Research Center on the Gifted and Talented, describes 2e learns as: 


Students who give evidence of the potential for high achievement capability in areas such as specific academics, and also give evidence of one or more disabilities as defined by federal or state eligibility criteria such as specific learning disabilities like speech/language disorders, emotional/behavioral disorders, physical disabilities, autism spectrum, or other impairments like attention deficit hyperactivity disorder (ADHD). (1)


Because there are so many combinations of 2e, it is difficult to identify this type of child. However, twice-exceptional children may be found in one of the following three categories:


  • May be formally identified as gifted but not have an identified disability. That is, the child’s giftedness masks the disability.

  • May be formally identified as having a disability but not identified as gifted. In other words, the disability has concealed the giftedness. 

  • The student may not be formally identified as either gifted or disabled because the components hide one another. To teachers and parents, neither giftedness nor disability is evident.


Misdiagnosis

Next, misdiagnosis - or the lack of a diagnosis - leads to harmful outcomes for the child.  In the well-respected book Misdiagnosis and Dual Diagnoses of Gifted Children (Webb, et al., 2016), misdiagnosis is a mismatch between the gifted child’s actual learning and health needs and the perception of those needs by others. (2)  The authors state that “this mismatch results in either a labeled mental health diagnosis and/or learning disorder being placed on the child when the behaviors or concerns can be better explained by giftedness; and/or a health disorder and/or learning need being overlooked, which may also be referred to as a missed diagnosis.”  (3) Either way, the result for the gifted/2e individual is not only inappropriate treatment but also a lack of appropriate interventions/accommodations in schools (and at work). 


There are many reasons why gifted/2e children receive so many diagnoses, of which some are incorrect. First, the traits or quirks that accompany giftedness and twice-exceptionality are often seen as mental disorders. Traits such as heightened sensitivities, perfectionism, introversion, overachieving behaviors, existential concerns, and asynchronous development (uneven intellectual, physical, and emotional development) are often questioned by those who do not understand these groups. Frequently, I observed normal giftedness confused with a diagnosable mental disorder, such as ADHD. One highly gifted boy I worked with for several years consistently had teachers eager to identify him with this learning difference because he talked a lot, had high levels of energy and was impulsive and easily distractible in some school settings.  Fortunately, this harm never came to this student because his parents and I educated his teachers along the way about the traits that often accompany a gifted individual. 


Second, it is unfortunate that there is still a lack of knowledge among professionals today when it comes to recognizing common gifted/2e characteristics. Professionals such as psychiatrists, psychologists, pediatricians, school counselors, administrators and even teachers receive little training that allows them to distinguish between behaviors that derive from giftedness as compared to behaviors that arise from diagnosable behavior disorders. (4) This lack of knowledge results in typical gifted behaviors being mistaken for one or more disorders. 


For years, I have encouraged school administrators to hire knowledgeable staff members who have advanced degrees in gifted education. Gifted intervention specialists can work side by side with the regular education teachers to help identify, plan, and work with the high potential students in the classroom, much like special education specialists do.  This commitment by schools ensures harmful mistakes will not happen. It only makes sense that if parents expect a trained specialist to help with a child’s physical health concerns, they should also expect nothing less than a knowledgeable specialist in their child’s school who can help with the needs of their gifted/2e child.


Third, there are disorders, such as existential depression or anorexia nervosa, that are more likely to occur among certain groups of gifted children and adults. (5)  Dr. James T. Webb (SENG founder), questioned the possibility that these types of disorders could be a result of temperament and environment. (6) If a diagnosis is correct, and it is caused by environment, then the diagnosing professional should consider that changing the environment could effectively treat many conditions. For example, if a gifted child is diagnosed with depression and anxiety after being relentlessly bullied in his public school, a better environment for the student should be considered such as a school for the gifted or homeschooling. The professional(s) in this case should always consider the student’s mental functioning along with their environment, whether it is home or school, before considering treatment. 


Finally, the disproportionate representation of students of color in special and gifted education is a serious concern that has lasted for decades. For example, according to the Coalition of Schools Educating Boys of Color, boys from minority and low-income backgrounds are underrepresented in gifted education and over-represented in special education. (7)  In addition, the Yale Child Study Center found in a two-year study (2016) persistent racial bias against Black students in classrooms, even starting at preschool level. (8) Teachers focused on Black students’ behaviors more than other students in the classroom. This led to inappropriate diagnoses like conduct disorder and/or oppositional defiant disorder. Furthermore, many low-income and minority children are never tested for giftedness, leaving many of these students with high intelligence and abilities undiscovered. (9)


Too many prominent studies have been completed regarding the inequity of gifted identification for us to ignore this problem anymore. One of these studies was from Purdue University’s Gifted Education Research and Resource Institute in 2019. (10) It explained that wealthy schools identify more children as gifted than do poor ones. Black, Latino, and Indigenous students are often left out. Furthermore, according to Dr. Donna Ford, professor at The Ohio State University, “There are many ways to go wrong when identifying gifted children and these ways result in few disadvantaged children, and more wealthy and white children, passing the bar.” (11) Some of the ways that keep Black and minority children from being identified gifted are (12):


  • Using achievement tests, which better measure a child’s schooling and home resources than their potential. 

  • Measuring disadvantaged children against a national norm instead of against other kids like them.

  • Testing too young- a 4-year-old can have a bad day, and the results don’t necessarily hold over time. 

  • Testing only students whose teachers or parents are aware of the program and request it. 

  • Few teachers get trained in gifted education, so their recommendations are often based on stereotypes.


Interventions/Accommodations

Failing to provide the appropriate interventions or accommodations for high potential students reminds me of the bald eagle I once saw in an enclosure at the zoo. An eagle in the wild is a sign of strength and power. It flies at high altitudes. It is tenacious, agile, and fast. It can hunt without its prey realizing it.  Although the eagle I saw had been injured and taken to a bird sanctuary, it will never realize its full potential, and it will be forever changed. Gifted students have strength and power too, until their educational journeys are thwarted by schools that do not understand and provide for their specialized needs. This can cause these children to experience trauma that may last a lifetime.


Just like there are many reasons gifted/2e children are often misdiagnosed, there are several reasons appropriate interventions and accommodations are not provided in schools. First, these children are not seen as neurodiverse with social/emotional and learning difference components. Like other special needs students, gifted children require specialized accommodations in school. They have needs that cannot be met through strategies that apply to the mainstream population of students. (13) Also, school systems separate children by age and expect all children to behave in essentially the same way at each age. An inappropriate academic setting can lead to significant social and behavioral issues. 


Next, parents often don’t want to ask for accommodations for their gifted children because they don’t want to “rock the boat” or feel like they are an elitist. Once, a parent approached me and said her daughter had already mastered long division by third grade. Needless to say, the child was bored to tears when she had to sit alongside her classmates and work on basic multiplication assignments. The parent felt if she approached the teacher to ask for something different for her daughter, she might “ruffle some feathers.”  Gifted kids are not better or worse than any other child. They are just different. It would be ludicrous to expect all children to be treated as if they have dyslexia, autism, diabetes or any other neurological or health issue. (14)


Some people will argue gifted programming (services) should be offered to all children or be eliminated altogether. Regardless of one’s position, it is important to remember “fair does not mean equal.” It is not fair to give a gifted child or developmentally delayed child the same assignments as everyone else in the class. The person who thinks that providing for children who are learning differently is an unfair advantage or privilege has not walked a day in the shoes of a person who is forced to be like everyone else in the room. Once, I participated in a technology class offered to teachers in my school district and experienced what my gifted students do in their regular classrooms. Many participants had to wait for those who were not tech savvy to catch up to the rest of us who were ready to begin designing websites and blogs. This disappointment led many teachers to quit the class.


Children cannot “quit” their classes when they are unhappy and unfulfilled. Therefore, providing adjustments, interventions, and/or accommodations for high potential children should be seen through the lens of providing opportunities, tools and measures, support, empowerment, and inclusion. Some effective education options include:


  • differentiation (A way to modify instruction to meet student’s individual needs.) (15)

  • curriculum compacting (An instructional technique involving replacement of content students know with new content, enrichment options or other activities.) (16)

  • grouping

  • pullout programs

  • grade skipping

  • independent study

  • competitions

  • mentorships

  • distance/online learning


Conclusion

Most children struggle in school at one time or another. However, when a student is correctly identified/diagnosed as gifted or twice-exceptional, they should never feel as though they are just surviving. Schools should have a plan in place to support this student. Again, we must remember, the myth the “gifted kid will be alright” does harm.  Misdiagnosing children with disorders based on traits that accompany giftedness and twice-exceptionality does harm. The belief it is unnecessary to tailor instruction to meet a child’s strength(s) does harm. Maya Angelou, poet, activist, and scholar, once said, “Do the best you can until you know better. Then when you know better, do better.” As adults, we often make mistakes because we don’t know the right way to do things. In the case of working with gifted/2e children, we must remember to make decisions that are likely to benefit the student and never do harm.


Endnotes

(1) Neumann, L. & Bade, M. (2009) A meeting of the minds on 2e. 2E Twice Exceptional Newsletter, 20. Retrieved from https://www.2enews.com/wp-content/uploads/2018/09/2e_Newsletter_Issue_35.pdf

(2) Webb, J. T., Amend, E. R., Beljan, P., Webb, N.E., Kuzujanakis, M., Olenchak, F.R. & Goerss, J. (2016). Misdiagnosis and Dual Diagnoses of Gifted Children and Adults (2nd ed.). Goshen, KY: Gifted Unlimited.

(3) Ibid

(4) Ibid

(5) Ibid

(6) Webb, J.T. (2014). Gifted children and adults. Neglected areas of practice. The National Register of Health Service Psychologists. The Register Report, 18-27.

(7) Gennarelli, D. (2022). Twice-Exceptional Boys: A Roadmap to Getting It Right. Goshen, KY: Gifted Unlimited. Also, for more information see: Changing the Narrative: Profiles of Young, Black Gifted Scholars (2017), by Ford, Davis & Granthan, and A Nation at Risk-How Gifted, Low Income Kids Are Left Behind, (2016), by Worrell and Wai.

(8) Hathaway, B. (2016). Implicit bias may help explain high preschool expulsion rates for black children. Retrieved from https://news.yale.edu/2016/09/27/implicit-bias-may-explain-high-preschool-expulsion-rates-black-children

(9) See: Simmons, D. (2018). Why are there so few students of color in gifted education: A conversation with Dr. Donna Ford. Retrieved from https://www.psychologytoday.com/us/blog/justice-in-the-classroom/201804/why-are-there-so-few-students-color-in-gifted-education; Payne, A. (2011). Equitable access for underrepresented students in gifted education. Retrieved from https://files.eric.ed.gov/fulltext/ED539772.pdf

(10) Dreilinger, D. (2020). America’s gifted education programs have a race problem. Can it be fixed? Retrieved from https://www.nbcnews.com/news/education/america-s-gifted-education-programs-have-race-problem-can-it-n1243143

(11) Ibid

(12) Ibid

(13) Bainbridge, C. (2020). When schools don’t meet your gifted child’s needs. Retrieved from https://www.verywellfamily.com/why-your-child-needs-an-appropriate-academic-setting-1449295

(14) Ibid

(15) Tomlinson, C. (2017). How to differentiate instruction in academically diverse classrooms. (3rd ed.). Alexandria, VA: Association for Supervision and Curriculum Development

(16) Reis, S., Renzulli, J., & Burns, D. (2016) Curriculum compacting: A guide to differentiating curriculum and instruction through enrichment and acceleration. New York: Routledge.


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Deborah is passionate about supporting gifted/2e children and their families. She has 35+ years of experience as an educator working in public and private settings with diverse student populations in three states. Deborah earned her master’s degree in gifted education from Kent State University. Her efforts to be the best teacher possible earned Teacher of the Year awards in three different school districts and an “All- County Teacher” award for her work to advance gifted education in schools and secure two considerable technology grants.


As a gifted intervention specialist, Deborah developed gifted education programs in several districts. These important programs ensured smart students were offered a variety of options to meet their needs in school ranging from curriculum compacting, mentorships, and acceleration. 


Now as a gifted consultant with her company Smart Strategies LLC, Deborah provides professional development to schools on topics related to gifted education and she consults with parents about their needs raising gifted children. She also speaks nationally about identification and support of gifted and 2e children.


Deborah’s book Twice Exceptional Boys: A Roadmap to Getting it Right was published in 2022 (Gifted Unlimited). She has also co-written a second book with author John Truitt due in the fall of 2024 (Gifted Unlimited) about navigating neurodiversity as a twice-exceptional adult. 


Deborah is a member of NAGC (National Association for Gifted Children), OAGC (Ohio Association for Gifted Children, and SENG (Supporting Emotional Needs of the Gifted). She can be found at: DeborahGennarelli.com and https://www.linkedin.com/in/deborahgennarelli/ or email her at: deb.gennarelli@gmail.com. 

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